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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Non-steroidal anti-inflammatory drug administration after coronary artery bypass surgery: utilization persists
Alexander Kulik1,2, Katsiaryna Bykov1, Niteesh K Choudhry1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Non-steroidal anti-inflammatory drug (NSAID) use after coronary artery bypass graft (CABG) surgery decreased following a 2005 FDA warning. However, NSAIDs are still prescribed, necessitating further research into their risks in CABG patients.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Health Policy
Background:
- The US Food and Drug Administration (FDA) issued a boxed warning in 2005 regarding cardiovascular safety concerns associated with non-steroidal anti-inflammatory drugs (NSAIDs) post-coronary artery bypass graft (CABG) surgery.
- NSAIDs are commonly used for pain management, but their use after major cardiac surgery requires careful consideration due to potential adverse effects.
Purpose of the Study:
- To assess the utilization rates of NSAIDs in patients undergoing CABG surgery before and after the 2005 FDA advisory.
- To identify predictors associated with NSAID administration following CABG surgery.
Main Methods:
- A cohort study included 277,576 patients who underwent CABG between 2004 and 2010.
- Temporal trends in NSAID exposure were analyzed, and predictors of postoperative NSAID use were determined using generalized estimating equations.
Main Results:
- NSAID administration decreased from 38.9% in 2004 to 29.0% in 2010, a statistically significant decline (p < 0.0007).
- Surgery after the FDA warning was linked to a 20% lower odds of NSAID use (OR: 0.80).
- Factors predicting lower NSAID use included renal disease, liver disease, and concurrent valve surgery, while mammary grafting increased NSAID use.
Conclusions:
- NSAID use after CABG has declined since the FDA advisory, but remains prevalent.
- Further research is needed to fully understand the risks of NSAID use in the CABG population.
Purpose:
In 2005, the US Food and Drug Administration (FDA) issued a boxed warning against the administration of non-steroidal anti-inflammatory drugs (NSAIDs) after coronary artery bypass graft (CABG) surgery because of cardiovascular safety concerns. We assessed utilization rates before and after the advisory and evaluated predictors of NSAID administration following CABG.
Methods:
We assembled a cohort of 277,576 patients who underwent CABG from 2004 to 2010. Temporal trends in NSAID exposure were evaluated, and predictors of postoperative NSAID use were identified using generalized estimating equations.
Results:
Over the study period, 92,938 CABG patients (33.5%) received NSAIDs following surgery. The frequency of NSAID administration declined steadily over time, from a peak of 38.9% in 2004 to a low of 29.0% in 2010 (p < 0.0007). Ketorolac was the most frequent NSAID prescribed, commonly on the first postoperative day. Surgery performed after the boxed warning was independently associated with a 20% lower odds of NSAID administration [odds ratio (OR): 0.80; p = 0.0003]. Other factors that predicted a lower odds of NSAID use following surgery included a history of renal disease (OR: 0.33; p < 0.0001) and liver disease (OR: 0.66; p < 0.0001), and the need for concurrent valve surgery (OR: 0.78; p < 0.0001). A mammary graft at the time of surgery increased the odds of NSAID administration (OR: 1.23; p < 0.0001).
Conclusions:
The frequency of NSAID administration after CABG has declined since the FDA advisory, yet many patients continue to receive them in recent years. Our data highlight the need for future research initiatives to further define the risks associated with NSAID use in this population.
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